International Journal of Clinical Oncology

, Volume 18, Issue 1, pp 54–61 | Cite as

Locoregional recurrence risk factors in breast cancer patients with positive axillary lymph nodes and the impact of postmastectomy radiotherapy

  • Tomoya Nagao
  • Takayuki Kinoshita
  • Nobuko Tamura
  • Takashi Hojo
  • Madoka Morota
  • Yoshikazu Kagami
Original Article

Abstract

Background

Locoregional recurrence (LRR) after mastectomy reduces the patient’s quality of life and survival. There is a consensus that postmastectomy radiotherapy (PMRT) helps establish locoregional control and reduces LRR in patients with ≥4 metastatic nodes. However, in patients with 1–3 metastatic nodes, the incidence of LRR and the role of PMRT have been the subject of substantial controversy. This study assessed the risk factors for LRR and the efficacy of PMRT in Japanese breast cancer patients with metastatic nodes.

Methods

This study analyzed 789 cases of invasive breast carcinoma with metastatic nodes from 1998 to 2008. We divided the study population into 4 groups: 1–3 positive nodes with/without chemotherapy and ≥4 positive nodes with/without chemotherapy. Risk factors for LRR were identified and the relationship between LRR and PMRT was analyzed.

Results

During the median follow-up of 59.6 months, 61 (7.7%) patients experienced LRR. In patients who received chemotherapy, independent LRR risk factors were high nuclear grade, severe lymphatic invasion, vascular invasion, and progesterone receptor-negative status in patients with 1–3 positive nodes, and severe lymphatic invasion and estrogen receptor-negative status in patients with ≥4 nodes. Although patients treated with PMRT had good outcomes, there was no significant difference, and PMRT did not significantly improve the outcome of the patients with all risk factors.

Conclusions

With systemic therapy and adequate dissection, PMRT by itself was of limited value in establishing locoregional control. The indication for PMRT in patients with 1–3 positive nodes remains controversial.

Keywords

Breast cancer Locoregional recurrence Postmastectomy radiotherapy Outcome 

References

  1. 1.
    Overgaad M, Hansen PS, Overgaard J et al (1997) Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med 337:949–955CrossRefGoogle Scholar
  2. 2.
    Ragaz J, Jackson SM, Le N et al (1997) Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 337:956–962PubMedCrossRefGoogle Scholar
  3. 3.
    Olson JE, Neuberg D, Pandya KJ et al (1997) The role of radiotherapy in the management of operative locally advanced breast cancer: results of a randomized trial by the Eastern Cooperative Oncology Group. Cancer 79:1138–1149PubMedCrossRefGoogle Scholar
  4. 4.
    Pierce LJ (2006) The use of radiotherapy after mastectomy: a review of the literature. J Clin Oncol 23:1706–1717CrossRefGoogle Scholar
  5. 5.
    Katz A, Strom EA, Buchholz TA et al (2001) The influence of pathologic tumor characteristics on locoregional recurrence rates following mastectomy. Int J Radiat Oncol Biol Phys 50:733–742Google Scholar
  6. 6.
    Overgaard M, Nielsen HM, Overgaard J (2007) Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 b&c randomized trials. Radiother Oncol 82:247–253PubMedCrossRefGoogle Scholar
  7. 7.
    Truong PT, Olivotto IA, Whelan TJ et al (2004) Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy. CMAJ 170:1263–1273PubMedCrossRefGoogle Scholar
  8. 8.
    Marks LB, Zeng J, Prosnitz LR (2008) One to three versus four or more positive nodes and postmastectomy radiotherapy: time to end the debate. J Clin Oncol 28:2075–2077CrossRefGoogle Scholar
  9. 9.
    Goldhirsch A, Glick JH, Gelber RD et al (1998) Meeting highlights: international consensus panel on the treatment of primary breast cancer. J Natl Cancer Inst 90:1601–1608PubMedCrossRefGoogle Scholar
  10. 10.
    Goldhirsch A, Glick JH, Gelber RD et al (2001) Meeting highlights: international consensus panel on the treatment of primary breast cancer. J Clin Oncol 19:3817–3827PubMedGoogle Scholar
  11. 11.
    Goldhirsch A, Wood WC, Gelber RD et al (2003) Meeting highlights: updated international expert consensus on the primary therapy of early breast cancer. J Clin Oncol 21:3357–3365Google Scholar
  12. 12.
    Goldhirsch A, Glick JH, Gelber RD et al (2005) Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005. Ann Oncol 16:1569–1583PubMedCrossRefGoogle Scholar
  13. 13.
    Goldhirsch A, Wood WC, Gelber RD et al (2007) Progress and promise: highlights of international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol 18:1133–1144PubMedCrossRefGoogle Scholar
  14. 14.
    The World Health Organization (1983) The World Health Organization histological typing of breast tumors second edition. Am J Clin Pathol 78:806–816Google Scholar
  15. 15.
    Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer. I. The value of histopathological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19:403–410PubMedCrossRefGoogle Scholar
  16. 16.
    The Japanese Breast Cancer Society (2008) General rules for clinical and pathological recording of breast cancer, 16th edn. Kanehara, Tokyo (in Japanese)Google Scholar
  17. 17.
    Tsuda H, Akiyama F, Kurosumi M et al (1998) Establishment of histological criteria for high-risk node-negative breast carcinoma for a multi-institutional randomized clinical trial of adjuvant therapy. Jpn J Clin Oncol 28:486–491PubMedCrossRefGoogle Scholar
  18. 18.
    Katz A, Strom EA, Buchholz TA et al (2000) Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implication for postoperative irradiation. J Clin Oncol 18:2817–2827PubMedGoogle Scholar
  19. 19.
    Wallgren A, Bonetti RD, Gelber RD et al (2003) Risk factors for locoregional recurrence among breast cancer patients: results from international breast cancer study group trials I through VII. J Clin Oncol 21:1205–1213PubMedCrossRefGoogle Scholar
  20. 20.
    Nielsen HM, Overgaard M, Grau C et al (2006) Loco-regional recurrence after mastectomy in high-risk breast cancer-risk and prognosis. An analysis of patients from the DBCG 82 b&c randomization trials. Radiother Oncol 79:147–155PubMedCrossRefGoogle Scholar
  21. 21.
    Yildirum E (2009) Locoregional recurrence in breast carcinoma patients. Eur J Surg Oncol 35:258–265CrossRefGoogle Scholar
  22. 22.
    Taghian A, Jeong JH, Mamounas E et al (2004) Patterns of locoregional failure in patients with operative breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five national surgical adjuvant breast and bowel project randomized clinical trials. J Clin Oncol 22:4247–4254PubMedCrossRefGoogle Scholar
  23. 23.
    Kyndi M, Sørensen FB, Knudsen H et al (2009) Response to postmastectomy radiotherapy in high-risk breast cancer: the Danish breast cancer cooperate group. J Clin Oncol 26:1419–1426CrossRefGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2011

Authors and Affiliations

  • Tomoya Nagao
    • 1
  • Takayuki Kinoshita
    • 1
  • Nobuko Tamura
    • 1
  • Takashi Hojo
    • 1
  • Madoka Morota
    • 2
  • Yoshikazu Kagami
    • 2
  1. 1.Department of Breast OncologyNational Cancer Center HospitalTokyoJapan
  2. 2.Department of Therapeutic RadiologyNational Cancer Center HospitalTokyoJapan

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